Urinary incontinence in women: non-pharmacologic approaches and newer pharmacotherapies

Stress urinary incontinence (SUI) is a common and bothersome problem for women. Sling surgery is the mainstay of surgical treatment of SUI. A review of PubMed literature using the following keywords was performed: stress urinary incontinence, women, sling, midurethral sling, mini-sling, outcomes, and complications. Literature within the last 10 years, systematic reviews, and meta-analyses were given preference. Slings placed at the bladder neck and the midurethra each corrects a particular anatomic weakness, as described in the "hammock hypothesis" and the "integral theory," respectively. At present, the literature suggests that the autologous bladder neck sling (BNS) and retropubic midurethral sling (MUS) have similar success rates, while the retropubic MUS appears to be more successful than the transobturator approach. The literature supporting single-incision mini-sling (SIMS) is still in the early stages and data to support its use over another MUS is absent. Each approach is associated with unique complications and adverse outcomes. While both BNS and MUS are effective in improving SUI in women, the ultimate choice of material and approach should be based both on surgeon experience and patient preference. Detailed informed consent discussion prior to any sling surgery cannot be overemphasized.